Albany County Fair
COUNTRY OF ORIGIN AFFIDAVIT/DECLARATION STATEMENT
Continuous Country of Origin Affidavit/Declaration: (This following affidavit could be used by any operation in
the livestock chain attestin to the Country of Origin of livestock but particularly for first-level producers.)( 4-H and
FFA members, this is the portion that the person you bought your animal from fills out, if you raised your animal
you fill this portion out)
As an affidavit is deemed by USDA as an official record of Country of Origin, I attest through first-hand knowledge,
normal business records, or producer affidavit(s) that all livestock referenced by this document or other
communications specific to the transaction and transferred are of __________________ (country) origin. Should
the origin of my livestock become other than that described above, I agree to notify the buyer/agent when this
occurs.
This affidavit/declaration shall remain in effect until revoked in writing by the undersigned and is delivered to
______________________(agent/buyer).
___________________________________________________________________________________
Signature
Date
Business/Farm/Ranch Names/Location
Origin Declaration Language for Seller/Buyer Invoices and Other Sales Documents with a Continuous Declaration
on Record or as a Stand-Alone Declaration of Origin: (The following statement would be used as a supporting
declaration of origin specific to transactions involving livestock from persons with a continuous affidavit on file, or
as a stand alone affidavit/declaration on specific transaction(s) on invoices. Check-in sheets and other sales
documents.)( 4-H and FFA members, this is the portion you fill out if you have brand papers, etc. and can not get a
signature from original seller)
I attest that all livestock referenced by this document and transferred are of ______________(country).
Signature:_____________________________________ Date:__________________________________
--------------------------Exhibitor fills out top portion of page. Bottom portion For Office Use Only-------------------------Appended Declaration Statement for Immediate/Direct Supplier Transactions to Packers: (Some packers may
request that their immediate/direct suppliers add the following language to the continuous or sales record
affidavit/declaration statements to affirm the period of time in which Country of Origin records would be
maintained by their immediate suppliers. This may be necessary as packers are required by law to maintain
Country of Origin records for one year and they must be able to obtain records from their immediate suppliers
within that one year period to substantiate Country of Origin claims.)
I attest that ___________________has and will maintain records of livestock origin for one year from the date of
delivery of the livestock to the packer/buyer.
I attest that these records reflecting specific transactions are available for inspection for the sole purpose of
compliance with an audit as described by the country-of-origin labeling provisions contained in the Farm Security
and Rural Investment Act of 2002 as amended. (P.L. 108-767, USCA section 1638a, 2003).
Exhibitor’s Name______________________________ _Species________________Animal Tag #_______________
Date Received by Fair Office____________